Podcast Episode 27: Shin Skin Tear

Hello my name is Kate Bain from The Wound Guy. In this podcast today we will outline some of the simple and yet important actions that can be undertaken if you or someone you care for sustains a wound to their shin. Throughout our lives knocks, bangs, scrapes, bruising and wounds are not uncommon on our shins. This area known as the pre-tibial region gets a hammering when we're young. We hurt ourselves as we learn to walk or start to ride a bike, engage in sport or just have that odd accident or two. Injury in our adult years doesn't seem to happen quite as often as when we were children and even if we do hurt ourselves we tend to recover pretty quickly. But as we reach our older years we aren't as robust as we once were. Our balance is perhaps not what it used to be, our vision is less acute, our reflexes are a bit slower and our navigating on uneven surfaces or in dark places is more uncertain. Consequently our shin tends to come to frequent blows with things like steps, furniture, doors, pets, garden borders, and even the occasional unsuspecting relative. There isn't a lot of soft tissue density between the bone, called the tibia, and the external hard surfaces. The tibialis anterior muscle lies next to the tibia bone, then there are layers of skin within which are our blood vessels, our superficial lymphatics, and nerve endings. When our lower leg bangs into a hard obstacle, sudden high pressure and tearing, or shear, can affect all the soft tissues, the skin, the adipose, and the muscle. And this trauma may then be evident as bruising, swelling, or breaks in the skin. Damage to the nerves can readily produce pain. Disrupted capillaries can ooze into the surrounding skin, causing large purple areas of discoloration or even blood blisters. Should the skin be broken, then bleeding and exudate can be alarming, especially if the injured party is on blood-thinning medicine or steroids or anti-inflammatory drugs or non-prescription agents, such as fish oil or curcumin. Skin tears to the shin region need to be treated quickly so that healing is expedited and the risk of non-healing or ulceration is minimized. The International Skin Tear Advisory Panel or ISTAP for short has an excellent website it's www.skintears.org. This has guidelines on the interventions to instigate when a skin tear wound happens and it also discusses the types of wound dressings that can be applied to these wounds. The key events in looking after a shin skin tear are firstly, stop the bleeding. So this may mean using sterile or clean gauze if you have some or a damp clean cloth to initially apply pressure over the injury to stem the flow of blood. Seaweed dressings called alginates can be applied directly to wounds to facilitate clotting. So people who have the combination of older age, thin skin and being anti-coagulated on blood thinners should keep a supply of these dressings readily at hand. A seaweed dressing or a simple pad like Melanin, Telfer or Release and a bandage can help to bring bleeding to a conclusion and can keep the wound safe until professional help is obtained should this be required? Secondly, relay the skin flap. So this point assumes that skin is still present, even if it's wrinkled, crinkled, curled or rolled in on itself. There are times that a skin flap, as we call it, may not be present and so the injury is then an open wound. However, should the skin flap be present, then When using a damp cotton bud along with some clean tweezers or a fine metal forcep, this can allow you to gently unravel the skin flap and place it gently onto the wound base. If you don't feel comfortable doing this, then leave the wound covered and have a health professional attend to this for you. The sooner that the bleeding stops and that the skin flap can go back onto the wound base, the more likely it is that the skin flap will survive and then the prolonged healing or a larger wound would be avoided. Thirdly, secure the skin flap in its relayed position. Holding that piece of skin back where it came from can be a challenge. Using paper adhesive strips like Steri-Strips is no longer recommended for this use. Utilizing skin glue could only really be done under expert guidance, as indeed should any thought of sutures or stitching. ISTAP's guidance on wound dressings advises that using silicon dressings is a safe and effective way of holding skin flaps in position while the tissues can then heal. Some silicon dressings need a secondary cover over the top, while some others are an all-in-one type of dressing. These dressings can frequently be left in place for a number of days at a time. This may even be able to be lifted off the skin to allow for inspection and then reapplied. Your doctor, nurse or pharmacist can provide information on what type of silicone dressing best suits your situation. Just like the seaweed dressing recommendation about having them on hand if you bleed freely when wounded, then if skin tears are not uncommon events for you, keeping some silicone dressings around you ready for use is a really good idea. Fourthly, apply compression from the toes to just below the knee. When there's an injury to the shin, with a skin tear present or not, there is damage to the superficial lymph flow that has passage through this region. This damage is most readily seen in the localized swelling or what we call edema that can become evident around the ankle or foot. So bandaging from toe to knee is an option but so is the utilization of a tubular bandage. So firm travel socks or compression hosiery can also provide this benefit but care may be required with their donning and doffing in order to avoid another shear related injury. Compression helps to facilitate lymph drainage and it accelerates soft tissue repair. In fact lower limb compression is so important when shin skin has torn or there's soft tissue damage that it alone can be the difference between uneventful healing or having wounds that are slow to heal. As always if you have any concerns see your health professional. Should you sustain a shin wound and then feel that little progress in healing is taking place, say within two weeks, then you should seek an expert opinion. The Lindsay Leg Club Foundation can put you in contact with a leg club or a clinician who can assist you. Thank you for listening. Bye for now.